SUDEP‐3: probable improvement in risk stratification for sudden death in epilepsy

Abstract

To the Editors, We thank Dr. Tarighati Rasekhi et al. for raising an important issue in sudden unexpected death in epilepsy (SUDEP) research: the risk stratification for sudden death in epileptic patients. We have carefully reviewed their recent article in Epilepsia titled, Improving prediction of sudden unexpected death in epilepsy: From SUDEP-7 to SUDEP-3, 1 and we wish to share our experience regarding SUDEP-3 and SUDEP-7 scales for sudden death risk stratification in patients with epilepsy.In our center at Hospital del Mar Barcelona, part of the European reference network EpiCARE, we have an active SUDEP line of research. From our cohort of 1250 patients, 7 patients died of SUDEP from 2010 to 2018, which makes an adult incidence in our population of 1.3 per 1000 epileptic patient-years. 2 Of the seven patients who died of SUDEP, six had SUDEP-7 scores of <6 at their last clinical follow-up, which would mean that they were at low risk of SUDEP according to this scale. However, when applying the SUDEP-3 scale, six of the seven deceased patients had scores ≥3, which was considered high risk. 1 The SUDEP-3 scale mainly weights the number of seizures but does not add cardiac or pulmonary risk factors that could make it a useful tool in clinical practice. However, in our cohort, it demonstrates a higher capacity to identify patients at risk of SUDEP than the SUDEP-7 scale, which could be of more help when considering comparative studies of high-and low-risk patients for identification of new biomarkers and risk factors.

Response: SUDEP‐7 Inventory: Validation in a retrospective cohort study

“…In addition, the only other published study of the SUDEP-7 found that it had poor correlation with SUDEP (Odom and Bateman). 4 We appreciate the feedback to date regarding the SUDEP-3 inventory, including a recent report highlighting the utility of the SUDEP-3 inventory 5 and are enthusiastic about further evaluations of the new inventory in larger cohorts.…”